500.3913 Home health care benefits.
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500.3913 Home health care benefits.
Sec. 3913.
(1)A long-term care insurance policy shall not limit or exclude services for home health care benefits in any of the following ways:
(a)By requiring that the insured would need skilled care in a skilled nursing facility if home health care services were not provided.
(b)By requiring that the insured first or simultaneously receive nursing or therapeutic services in a home or community setting before home health care services are covered.
(c)By limiting eligible services to services provided by registered nurses or licensed practical nurses.
(d)By requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of his or her licensure or certification.
(e)By requiring that the insured have an acute condition before home health care services are covered.
(f)By limiting benefits to services provided by medicare-certified agencies or providers.
(2)Home health care coverage may be applied to the nonhome health care benefits provided in the policy when determining maximum coverage under the terms of the policy.
(3)A long-term care insurance policy that provides coverage for home care services or assisted living services shall define and provide a detailed explanation in plain English of what home care services or assisted living services are covered. A long-term care insurance policy that provides coverage for assisted living facility stays shall define in plain English what assisted living facilities are covered.
History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2001, Act 4 , Imd. Eff. Mar. 30, 2001
Popular Name: Act 218